registration form

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St. John’s Preschool

2019-2020 Preschool Registration stjohnspreschoolnaperville.org

750 Aurora Avenue Naperville, IL 60540

630-355-1669

Registration Date _______________________________ Child’s Last Name __________________________ First Name ____________________ Gender __________ Name to be used at school ________________________ DOB ____/____/____ Age as of 9/1/19 _______ Street Address __________________________________________ City ______________________________ Zip ______________ Home Phone ______________________________ Member of St. John’s:

Y

N

Subdivision-and-School District _______________________________________________________________ ***DCFS requires 1st year students to present a Birth Certificate at the time of registration.

Parent/Guardian Information Please fill out completely. Mother/Guardian First Name __________________________ M.I. _______ Last Name _____________________________ Address _______________________________________________________________________________ Occupation _________________________________ Home Phone (

)____________ Cell Phone (

Employed By ___________________________ )____________ Office Phone (

)____________

Email Address _______________________________________________ Father/Guardian First Name __________________________ M.I. _______ Last Name _____________________________ Address _______________________________________________________________________________ Occupation _________________________________ Home Phone (

)____________ Cell Phone (

Employed By ___________________________ )____________ Office Phone (

)____________

Email Address _______________________________________________

St. John’s Preschool admits students of any race, ethnic, or faith background. Program Choice (Choose One Option) ____ 3-Day Option: Monday/Wednesday/Friday (8:45-11:45)

$245 per month

____ 3-Day Option: Tuesday/Thursday/Friday (8:45-11:45)

$245 per month

____ 4-Day Option: Monday/Tuesday/Wednesday/Thursday (8:45-11:45)

$295 per month

LEARN

•

PLAY

•

GROW

Enrichment Classes (Enrichment Only) ____ Little Van Gogh’s: Tuesday (12:30-2:00)

____ Mini-Mad Scientist: Wednesday (12:30-2:00)

____ Loving Literature: Thursday (12:30-2:00) 1 enrichment class: $55/month

2 enrichment classes: $110/month

3 enrichment classes: $148/month

Extended Day Choice (Includes rest time, provided lunch, and Enrichment 11:45 – 2:00) ____ 1 day per week

____ 2 days per week

____ 3 days per week

Additional $20 per month

Additional $40 per month

Additional $60 per month

A minimum of five students are needed in order to offer an enrichment class. If that minimum is not met a space will be made available for your child in another class.

A $75.00 registration fee must accompany this signed form. I understand that this non-refundable fee secures my child’s place at St. John’s Preschool for the 2019 - 2020 school year. Parent/Guardian Signature ___________________________________________ Date ___________________

I/We, _____________________________________ Parent/Guardian of ______________________________, Please Print Parent/Guardian Name(s)

Child’s Name

Hereby certify that I/we have received a copy of Summary of Licensing Standards and other materials published by the Illinois Department of Children and Family Services. Parent/Guardian Signature ___________________________________________ Date ___________________

I/We have read, understand, and agree to St. John’s Preschool’s policies on discipline, late pick-up, and pest control as contained in the 2018-2019 Parent Handbook. Parent/Guardian Signature ___________________________________________ Date ___________________

For Office Use Only

Reg. Fee $ _____________

Check # ___________ Birth Cert. ______

Cert. of Health ______

Emergency Form ______

Pick-up Form ______

Sign-in/Sign-out Form ______

Child Info. _______

Exit Date ______

LEARN

•

PLAY

•

GROW